Massachusetts RN Appeals Administrator
A company is looking for an RN Denials and Appeals Administrator, Per Diem.
Key Responsibilities
Manage the pre-denial, denial, and appeal processes, ensuring compliance with Utilization Review standards
Utilize medical necessity screening tools for initial and continued stay reviews to determine appropriate patient care levels
Collaborate with payers to secure authorization for clinical services in a timely manner
Required Qualifications, Training, and Education
Nursing degree: Diploma, ASN, or BSN (preferred), with the ability to obtain a BSN within 4 years
MA RN License required; CCM or ACM certification preferred
3-5 years of related experience in healthcare case management and patient insurance/billing
Preferred 3-4 years of supervisory experience
Comprehensive knowledge of clinical documentation, medical coding, and patient financial billing regulations
A company is looking for an RN Denials and Appeals Administrator, Per Diem.
Key Responsibilities
Manage the pre-denial, denial, and appeal processes, ensuring compliance with Utilization Review standards
Utilize medical necessity screening tools for initial and continued stay reviews to determine appropriate patient care levels
Collaborate with payers to secure authorization for clinical services in a timely manner
Required Qualifications, Training, and Education
Nursing degree: Diploma, ASN, or BSN (preferred), with the ability to obtain a BSN within 4 years
MA RN License required; CCM or ACM certification preferred
3-5 years of related experience in healthcare case management and patient insurance/billing
Preferred 3-4 years of supervisory experience
Comprehensive knowledge of clinical documentation, medical coding, and patient financial billing regulations